Health and Medical Insurance in Costa Rica
First, a disclaimer! The info on this page NOT up to date. I have not been able to get updated data so until I do, use the info below as a guideline and not the gospel! There have been changes to the limits from INS. I will update as soon as possible. July 2012
INS handles most types of insurance, but there are several international insurance carriers that offer far more robust health insurance policies with lifetime limits of $5 million and they will pay no matter what country you are in when the expenses are incurred. Some even have reduced premiums if you specify that expenses will ONLY be incurred in one country or in Central America. One of these is BUPA (this is NOT an endorsement and is placed here only as an example) but there are many others.
Often, there are links (ads) for other companies that offer expat insurance. These appear on the right side of this page. I would encourage you to examine them.
If you do not have legal residency, you may not buy the Costa Rica CAJA plans. Even if you do, buying a separate health insurance policy other than CAJA is an excellent idea. Some insurance carriers allow you to exclude counties like the USA. Doing this can drastically reduce the cost of coverage.
I cannot stress enough the need for good coverage. Many insurance agents specialize in expat coverage or simply coverage for those who travel internationally. Check them out and ask for recommendations. Socialized medicine is cheap but there are issues. You may have to wait months or even years for certain procedures, i.e. cataract surgery, joint replacement, etc. This is the drawback with any socialized medicine. That is why many people have supplementary policies in those countries that have socialized medicine
Note: While you cannot buy health insurance in Costa Rica from any other company than INS or CCSS**, these other policies I mention above are perfectly legal to purchase and many have payment arrangements already in place with several private hospitals in Costa Rica.
**With the passage of the Central American Free Trade Agreement (CAFTA), the restriction to buy only from INS or CCSS will change, and the market will open. I will update this page when the time comes.
In any case, you DO have options!
As with ANY insurance policy, always check for important provisions such as pre-existing conditions, age limits, cancellation policy and so on.
Besides the expat plans mentioned above, there two major health plans available for purchase here in Costa Rica.
INS (Instituto Nacional de Seguros)
INS offers medical insurance. INS is not part of CAJA (CCSS). The group plan offered by the Association of Residents of Costa Rica would save about 10% of the cost of the premium. There is a limit of about $17,500 per year, and it does not cover pre-existing conditions or check ups. Dental work, eyeglasses and cosmetic surgery are only paid if they are needed as the result of an accident. Claims are based on a table rating types of treatment administered. Costs vary with age and sex. This plan pays 70% of prescription drugs, examinations, doctor visits, hospitalization and treatment and 100% of surgeonsí and anesthetistsí fees. The patient is free to choose the doctor. Approximate annual premiums for men up to age 59 are $550, between ages 60 and 75 $1020. Dependants under 19 are about $245 per year. Women aged 19 to 59 would pay about $885 and between 60 and 75 $1,305.
NOTE: Currently, the annual benefit is only about $17,000. This seems very low, but $17,000 here spends a lot more than in the USA. Currently however, intensive care in a private hospital runs about $3,000 per day. At that rate, you can chew through your benefit pretty quickly. There are several companies worldwide that sell health insurance policies that cover you anywhere in the world and are perfectly legal in Costa Rica. Most have a $2 million limit and are not much more expensive than INS.
CCSS - Caja Costarricense de Seguro Social
An alternative to the INS plan is the CCSS plan. (Caja Costarricense de Seguro Social) This is the government medical plan that most Costa Ricans have. It is socialized medicine, so be prepared! It works very well for low-middle income groups, and you will get decent medical care, but lines are long, medicines are generic and may not work well, and as with all socialized medicine, you can wait years for some forms of surgery.
If you are an employer, payment for every employee is compulsory. The CCSS plan covers pre-existing conditions, doctor visits, prescription drugs, examinations, hospitalization, dental and eyes. There is no limit on annual amounts paid out by the plan. A doctor and clinic is assigned to the patient. Lines and the processes can be very long and waits of several months for an appointment are common.
CAJA is REQUIRED of all who seek legal residency here in Costa Rica. You may not obtain any form of residency without proof of CAJA coverage.
The cost through the Association of Residents of Costa Rica, ARCR, is very reasonable - $37.00 per month for a family where the principal insured person is over 55 years of age, and $58.00 per month where the principal insured is under the age of 55. For those under 55 there is a compulsory pension fund payment in the premium. Family includes spouse and dependants under the age of 18 years. Quoted prices are for the year 2004. Again... Insurance through CCSS Requires Costa Rican Residency and vice versa!
CAJA hospitals are open to ALL, whether you are a member of CAJA or not. You just have to pay!
Also, many doctors in the private hospitals are CCSS physicians and can often arrange billing through CCSS.